Since the 64405 specifies Greater occipital nerve I think you would follow the guidelines for billing a suboccipital nerve block the same way you would bill a lesser occipital block using 64450. I have never seen a recommendation on how to bill that block in CPT Assitant, webinar, coding site, or conference so I am not 100% sure.

Medial branch of the dorsal primary ramus of the second cervical nerve; sends branches to the semispinalis capitis and multifidus cervicis, but is mainly cutaneous, supplying the back part of the scalp.

Suboccipital nerve

Dorsal ramus of the first cervical nerve, passing through the suboccipital triangle and sending branches to the rectus capitis posterior major and minor, obliquus capitis superior and inferior, rectus capitis lateralis, and semispinalis capitis; the first cervical spinal nerve is generally considered to have only motor fibres, but the suboccipital nerve receives sensory fibres for proprioception via a communicating branch from the second cervical spinal nerve.

Lesser Occipital nerve
Arises from the ventral primary rami of the second and third cervical nerves; supplies the skin of the posterior surface of the auricle and the adjacent portion of the scalp. Posterior to the auricle.

This is a document that speaks about Cervical Plexus Blocks. Please look at the first paragraph, line 4 thru 6, under the ANATOMY heading.

Plus, an internal document that we use at the facility where I work indicates, "Use code 64413 for a Somatic Nerve Block at the C2-C4 level (Lesser Occipital, Greater Auricular, and Supraclavicular Nerves)"

BUT, there was an earlier thread on this subject on this forum that supported code 64450. See that discussion at the link below:

'The physician anesthetizes the cervical plexus for sympathetically mediated pain and anesthesia to the back of the neck and head. The physician draws a local anesthetic into three syringes and injects near the transverse processes of C2 to C4, avoiding vascular injection."

Here is a description from encoder for 64413. The only question I would have would be is the work involved better reflected with 64450 RVU 1.86 compared to 64413 RVU 2.09 since they are talking about using three syringes with possible fan-like injection compare blocking just the lesser occipital nerve.

If someone was auditing the encounter and they look at 64413. They could say I don't see mention of blocking the cervical plexus, but if you have 64450 it equates with blocking one nerve.

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